Recently, I reached out to my dear friend and colleague, Robyn L. Goldberg, RDN, CEDRD-S, to discuss the challenges in working with transgender youth and adults who suffer with eating disorders because I know her to be a compassionate and accepting clinician who embraces the transgender community with open arms. She’s conscious of personal preferences regarding recently emerged, non-binary pronouns and she’s truly kind. Robyn has worked with several of our clients in helping them understand the misconceptions about what is a normal weight, how to eat healthy for any body type, and how to disregard the BMI index. I am fortunate and grateful to have been a recent guest of hers in The Eating Disorder Trap Podcast: Episode #17: (Part 1) | Episode #18: (Part 2).

Have you seen in increase in diagnoses of eating disorders in the trans community over the last 5 years? Could you address what seems to have been a trend of trans teens and eating disorders?

Unfortunately, I have seen the increase in eating disorders over the last five years, especially in transgender youth. A survey of approximately three hundred thousand college students found that transgender college students had over four times great risk of being diagnosed with anorexia nervosa or bulimia nervosa, and two times greater risk of eating disorder symptoms such as purging compared to their cisgender female peers.[ reference #1 “Statistics & Research on Eating Disorders,” National Eating Disorders Association. | Reference #2 E.W. Diemer et al., “Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students,” Journal of Adolescent Health 57, no. 2 (August 2015): 144-149 ]

What are unique challenges trans people face regarding disordered eating?

There are several unique challenges that trans people face. Stigma and careless ignorance/naïveté make it difficult to find providers that understand them so their access to health care is limited by too few health practitioners wanting to learn and understand the transgender community. Combine that with the unique challenges include the body or beauty ideals the individual is experiencing and the fact that those folx are often not viewed in a positive manner by the public. It takes a team (including their family) to provide compassion and to be empathetic so the identified trans individual feels understood.

Do you approach your trans client’s disordered eating differently that you do your cisgender client? If so, how? How would you counsel a teen or mother of a trans teen vs. adult?

When I am working with my transgender client I, first (and always) ask them their preferred pronouns. We discuss what they like about their body, as difficult is that is for many transgender people. Sometimes a person can state they like the color of their hair or shape of their eyes as they become so fixated on what they want to look like, but it’s difficult for them to be in the moment. I work on helping them debunk food rules and beliefs that they have. There is so much reeducation about nutrition from diet culture that is necessary that learning how to develop a new relationship with food and their body is necessary to be successful at not having disordered thinking, let alone an eating disorder.

I would guide the parents of a trans teen by explaining to them it would be best if they didn’t share their food preferences, or give their recommendations. It is important that the teen goes through their own journey in regards to finding what food they like, feel safe eating and are not imposed onto them. It would be helpful if they ask their parents to be supportive by saying, for example, “we are having one of these various options for dinner, which one would you like?” Often times loved ones of clients have unresolved issues of their own with food and body and those views, in turn, are projected onto the identified trans youth. It’s important for the teen to have their own sense of identity and know that they can have a safe space with me.

Robyn Goldberg is a registered dietitian nutritionist, certified eating disorder registered dietitian supervisor, certified intuitive eating counselor and a Health at Every Size® (HAES) clinician. She has spent years learning from some of the best in the industry and continues to seek professional mentoring, attends innovative conferences and stays abreast with the most current literature. A nationally renowned contributing author registered dietitian nutritionist, Robyn has been quoted as an expert in various publications including The New York Times, The Huffington Post, Diabetes Forecast, Shape Magazine, Fitness, Oxygen, Life & Style, Natural Solutions, Beverly Hills Weekly and Today’s Dietitian. In addition, Robyn has also served as an eating disorder specialist on the nationally televised show “The Insider” and an expert on The Associated Press (AP). Most recently she authored The Eating Disorder Trap: A Guide for Clinicians and Loved Ones — available in paperback and as an audiobook — and has a wonderful, informative podcast similarly titled, The Eating Disorder Trap Podcast.